NCHS Data Brief ■ No. 128 ■ September 2013

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Use of Electronic Health Records in 

Residential Care Communities

Christine Caffrey, Ph.D., and Eunice Park-Lee, Ph.D.

Key findings 

• In 2010, only 17% of 

residential care communities 

in the United States used 

electronic health records.

• Residential care 

communities that used 

electronic health records 

were more likely to be 

larger, not-for-profit, chainaffiliated, colocated with 

another care setting, and in a 

nonmetropolitan statistical area. 

• The types of information 

most commonly tracked 

electronically by residential 

care communities that used 

electronic health records were 

medical provider information, 

resident demographics, 

individual service plans, and 

lists of residents’ medications 

and active medication allergies.

• Four in 10 residential 

care communities that used 

electronic health records also 

had support for electronic 

exchange of health information 

with service providers; nearly 

25% could exchange with 

pharmacies, and 17% could 

exchange with physicians.

The ability to record and exchange health information electronically is 

believed to improve the quality and efficiency of health care (1–4). It also has 

the potential to increase coordination of care across a continuum of providers, 

decrease duplication of testing (5), and allow providers timely access to 

necessary health information. Although research has been done in other health 

care settings (6–9), little has been focused on residential care communities’ 

use of electronic health records and their support for electronic exchange of 

resident health information (10). This report provides baseline findings using 

data from the 2010 National Survey of Residential Care Facilities (NSRCF).

Keywords: long-term care • health information technology • National Survey 

of Residential Care Facilities

Most residential care communities did not use electronic health 

records in 2010, and use varied by facility characteristics.

NOTES: For all characteristics, differences were significant at p < 0.05. Figure excludes cases with missing data; see “Data source 

and methods” section for details. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

Figure 1. Percentages of residential care communities using electronic health records, by selected 

community characteristics: United States, 2010

0 5 10 15

Percent

20 25 30

All residential care communities 17

4–25 beds 14

26 or more beds 25

Not-for-profit 26

Private, for-profit 16

Chain-affiliated 23

Not chain-affiliated 14

Colocated 29

Not colocated 14

Nonmetropolitan statistical area 22

Metropolitan statistical area 16
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• In 2010, only 17% of residential care communities used electronic health records (Figure 1).

• One-quarter of larger residential care communities (those with 26 or more beds) used 

electronic health records, compared with 14% of smaller communities (4–25 beds).

• Not-for-profit (26%) and chain-affiliated (23%) residential care communities were 

more likely to use electronic health records than for-profit (16%) and nonchain (14%) 

communities.

• Residential care communities colocated with another care setting (29%) and located in a 

nonmetropolitan statistical area (22%) were more likely than those not colocated (14%) and 

in a metropolitan statistical area (16%) to use electronic health records.

Residential care communities that used electronic health records varied in 

the types of information captured in their computerized systems.

Figure 2. Percentages of residential care communities using electronic health records that tracked selected types of 

resident health information in a computerized system: United States, 2010

NOTES: Figure excludes cases with missing data; see “Data source and methods” section for details. Figure also excludes types of information tracked by fewer 

than 30% of residential care communities, including orders for tests (29%), laboratory or imaging results (22%), reminders for guidelines-based interventions or 

screening tests (21%), and public health reporting (16%). 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

0 20 40 60

Percent

80

79

75

74

72

70

69

60

53

46

45

43

42

100

Orders for prescriptions

Warnings of drug interactions

Discharge and transfer summaries

Patient problems list

Clinical notes

Medication administration

Functional assessments

Active medication allergy list

Lists of residents’ medications

Individual service plans

Resident demographics

Medical provider information

• At least 7 in 10 residential care communities that used electronic health records also tracked 

medical provider information (79%), resident demographics (75%), individual service plans 

(74%), and lists of residents’ medications (72%) and active medication allergies (70%) using 

a computerized system.
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• More than one-half of residential care communities that used electronic health records 

tracked functional assessments (69%), medication administration (60%), and clinical notes 

(53%).

• About 4 in 10 residential care communities that used electronic health records tracked 

patient problems (46%), discharge and transfer summaries (45%), warnings of drug 

interactions or contraindications (43%), and orders for prescriptions (42%) (Figure 2).

• Less than one-third of residential care communities that used electronic health records 

tracked orders for tests (29%), laboratory or imaging results (22%), reminders for 

guidelines-based interventions or screening tests (21%), and public health reporting (16%). 

Less than one-half of residential care communities that used electronic 

health records had a computerized system that supported exchange of 

electronic health information with other service providers. 

Figure 3. Percentages of residential care communities using electronic health records that had a computerized system to 

support electronic health information exchange with other providers, by provider type: United States, 2010

1

Includes hospitals, nursing homes, and other long-term care providers. 

2

Includes laboratories, residents’ personal health records, and public health reporting.

NOTE: Figure excludes cases with missing data; see “Data source and methods” section for details. 

SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

0 10 20 30

Percent

40 50

40

23

20

17

17

Other2 17

Corporate office

Physician

Other health or long-term

care provider1

Pharmacy

Any provider

• Among residential care communities that used electronic health records, 23% had 

computerized systems for electronic health information exchange with pharmacies, and 17% 

could exchange with physicians (Figure 3). 

• One-fifth of residential care communities that used electronic health records had 

computerized support to electronically exchange health information with other health or 

long-term care providers, such as hospitals and nursing homes. 
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Summary

In 2010, 17% of residential care communities reported that they used electronic health records. 

These communities had different characteristics than those without electronic health records. 

Communities that had electronic health records were more likely to be larger, to have 

not-for-profit ownership, to be colocated with other care settings, and to be in a nonmetropolitan 

statistical area. Medical provider information, resident demographics, individual service plans, 

and lists of residents’ medications and active medication allergies were the most common 

categories of resident health information recorded using a computerized system. Forty percent of 

residential care communities that used electronic health records had a computerized system that 

supported electronic health information exchange with one or more types of service providers. 

Almost one-quarter had computerized support for exchanging electronic health information with 

pharmacies. 

This report has provided baseline findings on the use of electronic health record and electronic 

health information exchange systems by residential care communities. This information should 

be relevant to discussions on the role of residential care communities; the effective transition 

from hospitals to residential care communities or other long-term care settings; avoidable 

rehospitalizations; and helping persons who live with multiple chronic conditions better manage 

their health care. 

Definitions 

Residential care communities: Includes assisted-living facilities and similar residential care 

communities (e.g., personal care homes, adult care homes, board care homes, and adult foster 

care) that meet the study eligibility criteria described in the “Data source and methods” section.

Electronic health records: Use was identified based on provider self-report in response to the 

question, “Other than for accounting or billing purposes, does this facility use electronic health 

records? This is a computerized version of the resident’s health and personal information used in 

the management of the resident’s health care.” All providers were asked this question. 

Computerized resident health information: Use was identified based on provider self-report 

in response to the question, “Which of the following computerized capabilities does this 

facility have?” Included were 16 types of computerized resident health information: resident 

demographics, medical provider information, functional assessments, individual service plans, 

clinical notes, patient problems list, medication administration, lists of residents’ medications 

and active medication allergies, orders for prescriptions, warning of drug interactions or 

contraindications, orders for tests, laboratory and imaging results, reminders for guidelines-based 

interventions or screening tests, discharge and transfer summaries, and public health reporting. 

All providers were asked this question. 

Electronic health information exchange system: Use was identified based on provider self-report 

in response to the question, “Does this facility’s computerized system support electronic health 

information exchange with any of the following?” Nine different types of service providers were 

included: physician, nursing home, hospital, pharmacy, laboratories, other health or long-term 

care provider, residents’ personal health record, public health reporting, and corporate office. 

To be asked this question, residential care communities had to have a computerized system 
NCHS Data Brief ■ No. 128 ■ September 2013

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for tracking at least 1 of the 16 different types of resident health information. Residential care 

communities that did not track any of these types of information were coded as not having a 

computerized system that supported electronic health information exchange with other service 

providers. Four percent of residential care communities with electronic health records reported 

that they did not track any of these types of resident health information in a computerized system. 

Size: Categorized into two sizes based on the number of licensed, registered, or certified beds 

(occupied and unoccupied) in a residential care community: 4–25 beds and 26 or more beds.

Ownership type: Categorized into two ownership types: private, for-profit; and not-for-profit. 

The private, for-profit category included publicly traded facilities. Not-for-profit included private 

nonprofit, as well as state, county, or local government ownership. 

Chain affiliation: Having more than one community under common ownership or management. 

This may include communities in-state or across multiple states. If communties were owned by a 

chain, group, or multifacility system, they were coded as chain-affiliated. 

Colocation with another care setting: Determined based on provider self-report in response to 

the question, “Are any of the following types of places on the same property or at this same 

location?” Four types of places were included: independent living; nursing home; rehabilitation, 

subacute, or postacute unit in a nursing home; and hospital. Residential care communities were 

considered to be colocated with another care setting if they had one or more of these places on the 

same property or at the same location. 

Metropolitan statistical area: Refers to a county or group of contiguous counties that contain at 

least one urbanized area with a population of 50,000 or more. A metropolitan statistical area may 

contain other counties that are economically and socially integrated with the central county, as 

measured by commuting. 

Data source and methods

Facility data from the 2010 NSRCF, conducted by the Centers for Disease Control and 

Prevention’s (CDC) National Center for Health Statistics (NCHS), were used for these analyses. 

To be eligible for the study, residential care communities must (a) have been licensed, registered, 

listed, certified, or otherwise regulated by the state and have four or more licensed, certified, or 

registered beds; (b) have at least one resident currently living in the community; and (c) provide 

room and board with at least two meals a day, around-the-clock onsite supervision, and help 

with personal care such as bathing and dressing or health-related services such as medication 

management. These communities served a predominantly adult population. Communities 

licensed to serve severely mentally ill or intellectually or developmentally disabled populations 

exclusively were excluded. Nursing homes were also excluded unless they had a unit or wing that 

met the above definition and residents could be enumerated separately. 

The 2010 NSRCF used a stratified two-stage probability sampling design. The first stage was the 

selection of residential care communities from the sampling frame representing the universe of 

residential care communities in the United States. For the 2010 NSRCF, 3,605 residential care 

communities were sampled with probability proportional to size. Interviews were completed with 

2,302 residential care communities, for a first-stage community unweighted response rate of 79% 

and a weighted response rate (for differential probabilities of selection) of 81%. The second stage 
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involved the selection of current residents; details on this stage, and on other aspects of sampling 

design and data collection, are available elsewhere (11). 

Differences among subgroups were evaluated using chi-square and t tests. All significance 

tests were two-sided, using p < 0.05 as the level of significance. The difference between any 

two estimates is mentioned in the text only if it is statistically significant. Data analyses were 

performed using SAS-callable SUDAAN (12,13). Cases with missing data were excluded from 

the analyses on a variable-by-variable basis: 0.10% for electronic health records, 0.14% for 

computerized records of resident health information, and 0.13% for electronic health information 

exchange. Because estimates were rounded, individual estimates may not sum to totals.

About the authors

Christine Caffrey and Eunice Park-Lee are with CDC’s National Center for Health Statistics, 

Division of Health Care Statistics. 

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10. Hamann DJ, Bezboruah KC. Utilization of technology by long-term care providers: 

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NCHS Data Brief ■ No. 128 ■ September 2013

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Suggested citation

Caffrey C, Park-Lee E. Use of electronic 

health records in residential care 

communities. NCHS data brief, no 128. 

Hyattsville, MD: National Center for Health 

Statistics. 2013.

Copyright information

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the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

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Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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